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Application of Nasobiliary Duct Instead of T-tube in Laparoscopic Common Bile Duct Exploration and Primary Suture

Chinese Journal of Minimally Invasive Surgery.2014;(4):314-316. doi:10.3969/j.issn.1009-6604.2014.04.008

Objective To explore the application value of nasobiliary duct instead of T-tube in primary suture after laparoscopic common bile duct exploration (LCBDE). Methods A total of 58 cases of choledocholithiasis without acutecholangitis were divided into experimental and control group according to the odevity of the last number of admission number .Patients in odd number belonged to experimental group , while the even number patients belonged to control group .The experimental group received endoscopic nasobiliary drainage ( ENBD ) combined with LCBDE and primary suture;the control group underwent LCBDE combined with T-tube drainage .The intraoperative and postoperative data were compared between the two groups . Results All surgeries were completed successfully under laparoscope .The experimental group had much shorter hospital stay than that of the control group [(7.5 ±2.1) d vs.(10.3 ±3.2) d,t=-3.965,P=0.000].No significant differences were found in the operative time , incidence of bile leakage and postoperative incision pain between the two groups (P>0.05).All the cases were followed up for 6-12 months (average, 9 months) and no patients were hospitalized due to complications related to the billiary surgery .MRCP showed no complications such as biliary stricture and residual stones 6 months after operation . Conclusions Nasobiliary duct can substitute for T-tube in LCBDE .It ensures the safety of the primary suture and reduces T-tube related complications .

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Endoscopic-assisted Foley Catheterization for Bulbous Urethral Injury

Xinming ZHANG ; Zongyue YE ; Deying GUO

Chinese Journal of Minimally Invasive Surgery.2014;(4):367-369. doi:10.3969/j.issn.1009-6604.2014.04.025

Objective To evaluate the clinical methods and results of endoscopic-assisted catheterization in the treatment of bulbous urethral injury . Methods The clinical data of 19 cases of bulbous urethral injury from July 2004 to September 2012 managed by ureteroscopic catheterization were retrospectively analyzed . Results The procedures were successfully completed in all the 19 cases.Foley catheters were removed in 4-8 weeks after the surgery and all cases had unobstructed ureter after the removal of the catheter.Urethral dilatation was done regularly for 4 times and all the cases were followed up for 6-12 months afterwards.The follow-up showed urinary flow rate was more than 15 ml/s, and no urethral stricture , urinary incontinence or other complications occurred.Erection of penis was not obviously affected compared with preoperative condition . Conclusion Endoscopic-assisted catheterization is effective in the treatment of bulbous urethral injury .

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Clinical Value of Shortening Double-J Stent Indwelling Time in the Treatment of Ureteral Stone-street Complications after Flexible Ureteroscope Lithotripsy

Rui HUANG ; Xiaowen LIANG

Chinese Journal of Minimally Invasive Surgery.2014;(4):350-352. doi:10.3969/j.issn.1009-6604.2014.04.020

Objective To investigate the clinical value of shortening double-J stent indwelling time in the treatment of ureteral stone-street complications after flexible ureteroscope lithotripsy . Methods Clinical data of 38 cases of ureteral stone-street complications following flexible ureteroscope lithotripsy from January 2012 to December 2013 in our hospital were retrospectively analyzed.The patients were divided into Group A (extubating the double-J stent two weeks after the surgery ) and Group B (retaining the double-J stent) with 19 cases in each group .The stone clearance results were compared . Results All the urinary calculus in Group A had been removed successfully , including 2 cases of renal colic , 3 cases of irritative symptoms of bladder and 3 cases of gross hematuria.Hospital cost was (766.5 ±153.7) yuan.Urinary calculus were successfully removed in 13 cases in Group B, including 19 cases of gross hematuria and 17 cases of irritative symptoms of bladder.No renal colic occurred.The hospital cost was (1251.2 ± 155.6) yuan.Compared with Group B , Group A has higher success rate of stone clearance , lower hospital cost and lower rate of bladder irritative symptoms and gross hematuria (P<0.05).There were no significant differences between the two groups in the occurrence rate of renal colic (P>0.05). Conclusions Removing the double-J stent 2 weeks after flexible ureteroscope lithotripsy resulted in higher stone clearance rate and less complications compared with retaining the double -J stent.It can reduce the occurrence of irritative symptoms bladder and gross hematuria .

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Comparison Between Cervical and Extra-cervical Surgical Approaches for Endoscopic Thyroidectomy：a Randomized Controlled Study

Chengliang WU ; Gengzhen CHEN ; Hui HAN

Chinese Journal of Minimally Invasive Surgery.2014;(4):320-323. doi:10.3969/j.issn.1009-6604.2014.04.010

Objective To compare the therapeutic effects between cervical and extra-cervical surgical approaches for endoscopic thyroidectomy . Methods From October 2012 to December 2013, forty-four thyroid goiter patients were divided into two groups randomly .Group A underwent modified Miccoli endoscopic thyroidectomy ( n =20 ) and group B underwent endoscopic thyroidectomy via breast areola approach ( n=24 ) .The operative time , intraoperative blood loss , pain in 24 hours postoperatively , drainage volume , postoperative hospital stay , hospital cost , complication and cosmetic results between the two groups were compared . Results Compared with group B, group A had shorter operative time [(77.9 ±28.3) min vs.(97.9 ±30.0) min, t=-2.259, P=0.029], less intraoperative blood loss [(15.9 ±8.7) ml vs.(29.5 ±16.1) ml, t=-3.384, P=0.002], less pain in 24 hours postoperatively ( no pain, endurable pain , intolerable pain in group A and B were 15, 5, 0 and 7, 15, 2 cases respectively , Z=-3.066, P=0.002), less postoperative drainage volume [(31.7 ±10.3) ml vs.(57.0 ±14.6) ml, t=-6.511, P=0.000], but poorer cosmetic results (very dissatisfied, not satisfied, satisfied, comparatively satisfied, and very satisfied in group A and B were 1, 4, 5, 6, 4 and 0, 1, 4, 5, 14 cases respectively, Z=-2.723, P=0.006).There was no significant difference in postoperative hospital stay and hospital cost between the two groups (P>0.05).One case suffered transient hoarseness in group A and one case had trembling hand due to low calcium level in group B and both of them recovered 1 month after symptomatic treatment .No permanent recurrent laryngeal nerve injury , parathyroid injury or other complications occurred in both groups . Conclusions Cervical approach is minimally invasive and leads to good cosmetic results while extra-cervical approach causes bigger trauma but leads to better cosmetic results.Patients with high cosmetic reguest may choose endoscopic thyroidectomy via breast areola approach .

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An Experimental Study of Self-made Directional Arcuate Bone Drill in Percutaneous Vertebroplasty

Jun ZHANG ; Xinhu WANG ; Chunguang ZUO

Chinese Journal of Minimally Invasive Surgery.2014;(7):653-657. doi:10.3969/j.issn.1009-6604.2014.07.024

Objective To explore the application value of self-made directional arcuate bone drill during vertebroplasty by observing its operative effects for osteoporosis in vitro . Methods EDTA-Na2 was used to soak the prepared vituline osteoporotic vertebral bodies in vitro .A total of 40 osteoporotic vertebral bodies were randomly divided into Group A and B , with each group having 20 vertebral bodies for vertebroplasty .The Group A underwent a puncture by routine straight bone drill , while the Group B received a puncture by self-made directional arcuate bone drill with the arc directing toward the contralateral , which terminated when the drill reached the first 1/3 of vertebral body .Finally, statistical analysis was conducted on the distance between the bone drill bit and exterior margin of contralateral vertebral body , as well as whether bone cement reached or went over the vertebral sagittal midline . Results The osteoporotic vertebral bodies were successfully prepared in vitro by using EDTA-Na2 immersion decalcifying for 9 days. In the Group A, the drill bit was (2.50 ±0.32) cm away from contralateral exterior margin of vertebral bodies , which was significantly different from that in the Group B (0.90 ±0.26) cm (t=17.354, P=0.000).The bone cement reached or went over the vertebral sagittal midline in 11 vertebral bodies in the Group A and in 19 vertebral bodies in the Group B , with statistical difference ( Fisher’ s test,P=0.004).The intraspinal bone cement leakage occurred in 9 vertebral bodies in the Group A and 4 in the Group B, without significant difference between the two groups (Fisher’s test,P=0.176). Conclusion The self-made directional arcuate bone drill can build an osseous channel that reach or go over the vertebral sagittal midline and guide bone cement distributed to contralateral puncture , which avoids the disadvantages of bilateral vertebral pedicular puncture .The result shows that the self-made directional arcuate bone drill has more adventages in vertebroplasty than that of traditional straight bone drill but doesn ’ t have significant advantages in preventing bone cement leakage .

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Electrocoagulation of Gallbladder Artery in Laparoscopic Cholecystectomy

Xin CHENG ; Xinyi CHEN ; Youjun GAN

Chinese Journal of Minimally Invasive Surgery.2014;(7):667-668. doi:10.3969/j.issn.1009-6604.2014.07.028

Objective To investigate the safety and feasibility of electrocoagulation of gallbladder artery in laparoscopic cholecystectomy ( LC) . Methods A total of 376 patients with gallbladder benign diseases underwent LC in our hospital from May 2004 to September 2013.The gallbladder artery was treated by electrocoagulation . Results Because of unclear gallbladder triangle due to abdominal adhesion , conversion to laparotomy was performed in 9 patients.In the remaining 367 patients, three-port LC with electrocoagulation of the gallbladder artery was conducted successfully .Laparoscopic appendectomy was conducted simultaneously in 12 patients.An additional fenestration and drainage of the left renal cyst was performed in 1 patient.Postoperatively, a secondary bile duct exploration was conducted in 1 patient because of bile duct obstruction caused by common bile duct stones . Conclusion The electrocoagulation of gallbladder artery is safe and feasible in LC for the treatment of gallbladder benign diseases .

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Laparoscopic Ovarian-conserving Surgery for Ovarian Cyst Pedicle Torsion：Report of 62 Cases

Bin ZHANG ; Yan GUO ; Jingjing LI

Chinese Journal of Minimally Invasive Surgery.2014;(7):600-602. doi:10.3969/j.issn.1009-6604.2014.07.008

Objective To explore the value of laparoscopic ovarian-conserving restoration for ovarian cyst torsion . Methods A total of 62 cases of ovarian cyst torsion , 12 of which were combined with pregnancy , between January 2007 and June 2012 were retrospectively analysed .The surgical management involved laparoscopic high ligation of ovary blood vessels , restoration of the ovary, and resection of ovarian cysts . Results All the 62 cases of laparoscopic restoration were successfully performed with ovarian reservation.The cysts twisted for 180°~1080°, including 19 cases of <360°, 21 cases of 360°~720°, and 22 cases of >720°.The cysts were coloured purple black in 26 cases, purple or normal in 36 cases.The operation time was (57 ±23) min, the intraoperative blood loss was 5-130 ml (mean, 50.6 ml), and anal exsufflation time was (24 ±13) hours.No embolism, infection, and abortion occurred during post-operation.The level of estrogen recovered to normal in 1-3 months postoperatively .Ovulation at the procedure side was found in 43 cases in 6-24 months. Conclusions Laparoscopic ovarian-conserving surgery is a safe procedure for ovarian cyst pedicle torsion .High ligation of ovarian blood vessles and resection of ovarian cysts can not only avoid the possibility of thrombosis but also preserve the ovarian functions .The shortage of this operation is complicated to perform .

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Application of Myomectomy by Extrusion During Cesarean Sections

Yongmei CHEN ; Zhi LI ; Aijun WANG

Chinese Journal of Minimally Invasive Surgery.2014;(7):594-596. doi:10.3969/j.issn.1009-6604.2014.07.006

Objective To evaluate the safety of myomectomy by extrusion in cesarean section , in comparison with routine cesarean delivery. Methods From January 2008 to December 2010, a total of 128 operations of myomectomy by extrusion in cesarean section were performed (Myoma Group), while another group of 128 cases undergoing caesarean section , which respectively followed every cases of the Myoma Group but had no hysteromyoma , was selected as the control group .The amount and rate of postpartum hemorrhage , the level of postpartum fever , and postoperative hospital stay between the two groups were compared , respectively. Results In the two groups:the amount of postpartum hemorrhage was (233.6 ±58.9) ml vs.(228.5 ±90.9) ml (t=0.530, P=0.597); the rate of postpartum hemorrhage was 0% (0/128) vs.0.8% (1/128) (P=1.000); the decrease of haemoglobin was (6.17 ±2.83) g/L vs.(6.89 ±3.09) g/L (t=-1.944, P=0.053); the decrease of hematocrit was 2.22%± 0.98%vs.2.27%±1.02% (t=-0.400, P=0.690); the rate of postpartum fever was 2.3% (3/128) vs.5.5% (7/128) (χ2 =1.665, P=0.197);the length of postoperative hospital stay was (4.2 ±0.8) d vs.(4.1 ±1.2) d (t=0.706, P=0.481). There were no significant differences between the two groups in the abovementioned parameters . Conclusions The myomectomy by extrusion in cesarean section does not increase the level of postpartum hemorrhage and the rate of postpartum infections .It is a simple, minimally invasive , safe and feasible surgical method , being worthy of clinical application .

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Total Laparoscopic Hysterectomy Versus Total Abdominal Hysterectomy:a Retrospective Comparison of Clinical Effects and Sexual Functions

Yingying ZHOU ; Xiaoyan YING

Chinese Journal of Minimally Invasive Surgery.2014;(7):588-590. doi:10.3969/j.issn.1009-6604.2014.07.004

Objective To investigate two different hysterectomy ( total abdominal hysterectomy and total laparoscopic hysterectomy ) on short-term efficacy and influence on sexual functions . Methods The retrospective records of 100 cases of total laparoscopic hysterectomy ( TLH) and 100 cases of total abdominal hysterectomy ( TAH) from January 2009 to December 2012 were reviewed.The operation time, intraoperative blood loss, postoperative hospital stay, and sexual satisfaction at 12 months postoperatively were compared between the two groups . Results The operation time was longer in the TLH Group than that in the TAH Group [(128 ±11) min vs.(87 ±33) min, t=-11.787, P=0.000].The intraoperative blood loss was less in the TLH Group than that in the TAH Group [(108 ±37) ml vs.(155 ±28) ml, t=-10.129, P=0.000].The hospital stay was shorter in the TLH Group than that in the TAH Group [(5.5 ±1.9) d vs.(8.2 ±1.6) d, t =-10.870, P =0.000].There were no significant differences between the two groups in sexual frequency (Z=-1.300, P=0.193), libido (Z=-0.564, P=0.573), achievement of orgasm (Z =-1.591, P=0.112), sexual intercourse disorder (Z =-0.478, P =0.633), and the overall satisfaction (Z=-0.083, P=0.934).Extent of dyspareunia was worse in the TLH Group than in the TAH Group (Z=-3.752, P=0.000). Conclusions TLH has less blood loss and shorter hospitalization time than TAH .Hysterectomy has a certain influence on sex functions .Differences in the sexual satisfaction are not statistically significant between the two procedures .

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Breast Conserving Surgery in Patients with Early Breast Cancer After Local Lumpectomy

Faliang XU ; Wenyan WANG ; Xiang WANG

Chinese Journal of Minimally Invasive Surgery.2014;(7):577-579. doi:10.3969/j.issn.1009-6604.2014.07.001

Objective To explore the feasibility and safety of breast conserving surgery ( BCS) in patients with early breast cancer after local lumpectomy . Methods Clinical data of 26 patients who previously had received local lumpectomy from January 2009 to December 2011 were retrospectively analyzed .All the patients were diagnosed as solitary invasive ductal carcinoma with preoperative staging of T1N0M0.The interval from lumpectomy to BCS was 6-24 days (mean, 10 days) and the maximum diameter of tumors before first operation was 1-2 cm (mean, 1.6 cm).The shortest distance between nipple and operative incision was 2-6 cm (mean, 4.5 cm). Results The operations were successfully completed in all 26 patients, 15 of which received sentinel lymph node biopsy and 11 of which received axillary lymph node dissection .The hospital stay was 3-5 days with stage-Ⅰhealing of incision .All patients received whole breast radiation therapy after BCS .There was no local recurrence or distant metastasis during 2 -5 year ’ s follow-up (median, 32 months).All the patients were satisfied with the shape of breast and the quality of life . Conclusion For those patients with early breast cancer who have received local lumpectomy , meet the requirement of CBS , and have the willing of breast conserving , BCS is an ideal choice after rigid application of surgical indications .

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